What is the mechansim of LV dysfunction in RHD ?

The answer is simple . There is no primary rheumatic myocardial dysfunction .The LV dysfunction is related to the valvular lesion especially mitral regurgitation. While this is 100 % true in chronic RHD , surprisingly it holds good even in acute rheumatic fever as well .(I have been thinking acute myocarditis is responsible for most cases of cardiac failure in Acute rheumatic fever !)

It is a paradox to note myocardits being a major component in acute rheumatic fever (ARF) , still it does not persist long term .It invariably resolves and the injury to the valves goes on to result in progressive valve damage .

It is heartening to note this phenomenon in ARF , as myocardial involvement behaves just like joint involvement

Shall we modify the famous statement of the canadian Pathologist William Boyd “Rheumatic fever licks the joint but bites the heart”

Though ARF bites the heart , it relishes only the valve tissue and bites it harder , while it simply licks the myocardium like the joints

Is there a chronic indolent myocarditis ?

It was Initially thought there could be process of chronic myocardial inflammation.But now it is almost proven there is no entity like that .

But , it is not uncommon some patients with RHD present with significant LV dysfunction which in all probability unrelated to rheumatic activity .